Association of Lower Extremity Lymphedema With Physical Functioning and Activities of Daily Living Among Older Survivors of Colorectal, Endometrial, and Ovarian Cancer

Abstract

IMPORTANCELower extremity lymphedema (LEL) is associated with decreased physical functioning (PF) and activities of daily living (ADLs) limitations. However, the prevalence of LEL in older survivors of cancer is unknown. OBJECTIVES To examine LEL among older female survivors of colorectal, endometrial, or ovarian cancer and investigate the association of LEL with PF and ADLs. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study was conducted using data from postmenopausal women enrolled at 40 US centers. Participants were women who had a prior diagnosis of endometrial, colorectal, or ovarian cancer and who had completed the WHI LILAC baseline and year 1 follow-up questionnaires as of September 2017. EXPOSURES The 13-item Lower Extremity Lymphedema Screening Questionnaire in Women was used to determine LEL (ie, score Ն5). MAIN OUTCOMES AND MEASURESValidated surveys were used to assess PF and ADLs. RESULTS Among 900 older women diagnosed with endometrial, colorectal, or ovarian cancer, the mean (SD) age was 78.5 (5.9) years and the mean (range) time since cancer diagnosis was 8.75 (1.42-20.23) years. Overall, 292 women (32.4%) reported LEL, with the highest LEL prevalence among survivors of ovarian cancer (38 of 104 women [36.5%]), followed by survivors of endometrial cancer (122 of 375 women [32.5%]) and colorectal cancer (132 of 421 women [31.4%]). Compared with women without LEL, women with LEL had a PF score that was lower by a mean (SE) 16.8 (1.7) points (P < .001) and higher odds of needing help with ADLs (odds ratio [OR], 2.45; 95% CI, 1.64-3.67). In the association of LEL with PF, the mean (SE) decrease in PF score was greatest among survivors of colorectal cancer (−21.8 [2.6]) compared with survivors of endometrial cancer (−13.3 [2.7]) and ovarian cancer (−12.8 [5.2]). Additionally, among survivors of colorectal cancer, LEL was associated with increased odds of needing help with ADLs (OR, 3.59; 95% CI, 1.94-6.66), while there was no such association among survivors of endometrial cancer or ovarian cancer. However, there were no interaction associations between LEL and cancer type for either outcome. Additionally, the overall mean (SE) difference in PF between women with and without LEL was greater among those aged 80 years and older (−19.4 [2.6] points) vs those aged 65 to 79 years (−14.9 [2.2] points). However, among survivors of colorectal cancer, the mean (SE) difference in PF score was greater among women aged 65 to 79 years (−22.9 [3.7] points) vs those aged 80 years or older (−20.8 [3.7] points) (P for 3-way interaction = .03).

A non-randomized, open-label study of the safety and effectiveness of a novel non-pneumatic compression device (NPCD) for lower limb lymphedema

“…It has been estimated that between 2012 and 2017, more than $1B was spent on lymphedema-related hospitalizations; often hospitalizations involving the lower extremities are more costly than those for upper extremities 11 . The physical limitations imposed by LEL have been shown to increase the likelihood of needing assistance with activities of daily living 12 , which can impose significant costs to patients.…”

Vascular Diseases in Women: Do Women Suffer from Them Differently?

“…Among breast cancer survivors, patients with lymphedema had significantly higher medical costs, hospitalizations, and medical visits than those without lymphedema [133,134]. Among female survivors of other cancers, those with lymphedema reported lower physical function and required more assistance for activities of daily living [135]. Lifting restrictions, limited mobility, and fear of infections restrict the possibilities of actively participating in work, hobbies, or sports.…”

The N-LVA Study: effectiveness and cost-effectiveness of lymphaticovenous anastomosis (LVA) for patients with cancer who suffer from chronic peripheral lymphoedema – study protocol of a multicentre, randomised sham-controlled trial

“…In addition, patients may also experience a variety of psychosocial symptoms, such as depression, anxiety, and difficulties in social, domestic, vocational, and sexual domains. Altogether, patients with CRL may experience a diminished health-related quality of life (HRQoL) in comparison with cancer survivors who have not developed lymphoedema 4–8…”

“…Open access in comparison with cancer survivors who have not developed lymphoedema. [4][5][6][7][8] CRL can arise after oncological treatment for several solid tumour types, including breast, melanoma, head and neck, gynaecological and genitourinary malignancies. 9 While it may manifest in various regions of the body, it predominantly affects the upper and lower extremities.…”